Premature rupture of membranes (PROM), as it relates to pregnancy, is the rupture of an amniotic membrane enclosing a fetus before the onset of labor. In most cases, PROM occurs near term, but when membrane rupture occurs before 37 weeks gestation, it is referred to as preterm-PROM (PPROM) or simply PROM. PROM complicates approximately 3-4% of pregnancies and leads to 30-40% of all preterm births—approximately 150,000 cases annually in the United States (US) alone.
PROM is most commonly caused by a bacterial infection, by smoking, or by a defect in the structure of the amniotic membrane, uterus, or cervix. This condition is termed spontaneous PROM. In rare cases, the rupture can heal, but in most cases of preterm PROM, labor begins within one week after rupture. Accordingly, one of the most common complications of preterm PROM is premature delivery and its associated risks, including perinatal and neonatal complications. Neonates surviving preterm PROM may develop sequelae, such as malpresentation, cord compression, oligohydramnios, necrotizing enterocolitis, neurologic impairment, intraventricular hemorrhage, or respiratory distress syndrome, and 1-2% even face the risk of fetal death. These sequelae are most common when PROM occurs before 32 weeks gestation and results in premature delivery.
PROM can also be the result of iatrogenic causes due to surgical manipulations during pregnancy. Fetoscopic procedures, amniocentesis, and amnioreduction are associated with a risk for PROM.